Medstar caught in tangle of regulation

Oct. 7, 2012

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State officials told Lee County staffers they could skip safety standards and obtain a helicopter license for Medstar to fly.

The state’s application for a helicopter license requires officials swear to comply with federal rules for maintenance and inspection, according to Lee County’s January 2011 application.

It also mandates officials turn over a federal certificate to prove they have met those standards, according to the Lee County’s application.

But Department of Health officials “verbally advised” a Lee County finance manager they would issue the license without the requirements as long as Lee County agreed to fly for free, Department of Health spokeswoman Ashley Carr said.

State officials could not cite any written authority that allowed them to make that exception and issue a license to Lee County in March 2011.

Once county officials obtained the state license, they disregarded the state’s provision and charged for $3.3 million in medical flights. County Manager Karen Hawes has said the bills were an honest mistake.

While insurers such as Medicaid require the state license, they had no way to know about the undocumented deal with Lee County.

The state’s publicly available “license verification” website showed Lee County had a valid license, but fails to note the helicopter could only conduct free flights because it didn’t meet safety standards, according to state license documents and the Department of Health’s website.

The bills Lee sent out and money it collected violated federal rules and triggered an investigation by the Federal Aviation Administration.

Federal guidelines allow government agencies to avoid the safety standards, provided they don’t charge for flights. Many private and government operators, however, choose to comply with the rules.

A 2005 special report from the National Transportation Safety Board recommended all air ambulances meet the safety rules, which regulate maintenance, inspection and pilot training programs.

That report was issued amid an uptick in air ambulance crashes. One of Lee County’s medical helicopters crashed off North Captiva in 2009. Two paramedics and the pilot escaped without serious injury.

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In the state license application, Lee County’s public safety finance manager, David Kainrad, guarantees the county will meet the federal standards for maintenance and inspection.

He signed the application, above a paragraph that advises that false official statements are a second-degree misdemeanor, according to the Jan. 4, 2011, application.

It took another 18 months for Lee to obtain the federal document, which certifies compliance with the safety rules and is required by the state application.

Meanwhile, state officials accepted what Carr called an “amended” document.

Lee officials finally acquired the certificate just two weeks before they suspended Medstar and grounded the county’s medical helicopters.

Kainrad said it wasn’t until Medstar was suspended that the state asked him for the valid certificate.

“I didn’t even know what that was when the state had called me, when this whole thing came to be at the end of August, September,” Kainrad said. “I’ve been doing the licensing since the ’80s, this is the first somebody asked for it.”

The state has required the safety certificate for more than three years, according to the application, which was last revised April 9, 2009.

When county officials suspended Medstar, they initially claimed it was temporary measure that would help them obtain a voluntary accreditation from an out-of-state organization.

But in the weeks that followed, Hawes admitted the county failed to meet federal safety rules and that inability factored into Medstar’s suspension.

County officials are looking for a company to take over the service. The cost to patients and, possibly, taxpayers has not been defined.

Department of Health officials have no plans to look into the matter, as they have not received a complaint, Carr said.

“As with all complaints, if a complaint were to be filed, it would be thoroughly examined and would be reviewed by a probable cause panel to determine whether cause exists to move forward through the disciplinary process,” Carr said.